Blog Archives

Contemporary management of acoustic neuromas

Conclusions:
Our review of the literature suggests that near-total or extensive subtotal resection of vestibular schwannomas may confer much improved functional outcomes without significant detriment to acceptable rates of tumor control. However, further follow-up is needed in patients treated with this relatively novel surgical paradigm.

from The Laryngoscope

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Speech understanding in noise with an eyeglass hearing aid: Asymmetric fitting and the head shadow benefit of anterior microphones

Conclusions: By integrating microphones in an eyeglass frame, a long array can be used resulting in a higher directionality index and improved speech understanding in noise. An asymmetric fit did not significantly reduce performance and can be considered to increase acceptance and environmental awareness. Directional microphones at the temple seemed to profit more from the head shadow than above the pinna, better suppressing noise from behind the listener.

from the International Journal of Audiology

Predictors of Returning to Oral Feedings After Feeding Tube Placement for Patients Poststroke During Inpatient Rehabilitation

Objectives: To identify the frequency and characteristics of patients admitted to inpatient rehabilitation (IPR) following a stroke who are able return to oral feedings and have their feeding tube (FT) removed prior to discharge from IPR, the timing of FT removal, and implications for outcomes.Methods: Medical records were identified by admission rehabilitation impairment code (RIC) for stroke (RIC 01), and reviews were completed by two physiatrists and two speech language pathologists. At random, 25% of the charts were reviewed by a second rater for data quality control. Measures collected during the chart review included the following: age, gender, onset of stroke, rehabilitation length of stay (LOS), admission and discharge FIM™, discharge destination, diet level, and feeding tube status.Results: One hundred forty-three patients were identified as subjects for this investigation who had an FT and were NPO upon IPR admission. Overall, 46.9% (67/143) of the patients returned to three meals daily prior to discharge from IPR. The mean days post stroke onset until returning to three meals daily was 38.43 days (SD = 26.36). Twenty percent (30/143) of the patients were able to have their FT tube removed prior to discharge from IPR. Factors associated with returning to three meals included gender (ie, female), longer IPR LOS, and higher admission FIM™ scores at IPR. Factors associated with removal of the feeding tube included a longer IPR LOS and younger age. Patients who were able to have their FT removed were more likely to be discharged to home.Conclusion: Individuals with longer IPR LOS were more likely to return to three meals daily and have their feeding tubes removed prior to discharge.

from Topics in Stroke Rehabilitation

Behavioral and Physiological Responses to Child-Directed Speech as Predictors of Communication Outcomes in Children With Autism Spectrum Disorders

Conclusions: Behavioral and physiological responses to CDS are significantly related to concurrent and later communication skills of children with ASD. Furthermore, higher vagal activity during CDS predicts better communication outcomes 12 months later, after initial communication skills are accounted for. Further research is needed to better understand the physiological mechanisms underlying variable responses to CDS among children with ASD.

from the Journal of Speech, Language, and Hearing Research

Outcome Measures Used in Studies of Botulinum Toxin in Childhood Cerebral Palsy: A Systematic Review

This literature review uses the International Classification of Functioning, Disability and Health to describe the quality and variety of the studies of botulinum toxin in children with cerebral palsy since 2001. Articles were identified via electronic query and then reviewed for strength of evidence and classification of outcome measures. The distribution of levels of evidence for the 63 articles was I (n = 8), II (n = 12), III (n = 21), and IV (n = 22). One or more measurements were used in the International Classification of Functioning, Disability and Health domains of body structure and function (47 papers), activity (47 papers), participation (12 papers), and environmental/personal factors (10 papers). A total of 67% of all outcomes demonstrated a significant difference (I 49%, II 39%, III 74%, IV 88%). This review illustrates that few studies provide a high level of evidence and that outcomes focus on arenas such as spasticity or range of motion rather than activity or participation domains such as walking.

from the Journal of Child Neurology

Electroglottogram approximate entropy: a novel single parameter for objective voice assessment

Conclusion: Electroglottogram approximate entropy can be used to assess change in voice quality resulting from glottic morphological abnormality. Electroglottogram approximate entropy values improve as voice quality improves after treatment. Electroglottogram approximate entropy values correlate significantly with grade–roughness–breathiness–asthenia–strain scale results.

from the Journal of Laryngology and Otology

Five-Year Longitudinal Treatment Outcomes of the ISTAR Comprehensive Stuttering Program

Replicated evidence of satisfactory 1- and 2-year post-treatment outcomes has been reported for the Comprehensive Stuttering Program (CSP). However, little is known about longer-term outcomes of the CSP. Yearly follow-up measures were obtained from 18 participants for 5 consecutive years. At 5-years follow-up, participants were maintaining clinically and statistically significant reductions in stuttering and increases in rates of speech relative to pre-treatment measures. Standardized effect sizes were large. There were no significant differences among the immediate post-treatment and five follow-up measures, indicating that speech gains achieved by the end of the treatment program were stable over the 5-year follow-up period. Insufficient return rates for self-report data for the third to fifth follow-up measurement occasions prohibited analyzing these data. However, non-significant differences among the immediate post-treatment and two follow-up measures indicated that improvements achieved by the end of treatment in speech related confidence, and perceptions of struggle, avoidance, and expectancy to stutter were stable over the 2-year follow-up period. Significant differences among the speech related communication attitudes scores indicated that improvements in attitudes made at the end of the treatment program were less stable. Taken together, these results provide further and longer-term evidence of the effectiveness of the CSP.

from Journal of Fluency Disorders

Predicting functional outcome after stroke by modelling baseline clinical and CT variables

Conclusion: this study demonstrates an externally validated stroke outcome prediction model using simple clinical variables. Outcome prediction was not significantly improved with CT-derived radiological variables or more complex clinical variables.

from Age and Ageing

Patient Factors Related to Voice Therapy Attendance and Outcomes

Limited information is available concerning factors that may be associated with attendance and outcomes among patients referred for voice therapy. The purpose of this study was to determine whether patient-related factors could be identified which distinguished patients who attended voice therapy and had positive voice change from those who did not. This retrospective study included medical record information for 100 patients seen at a major urban, academic medical center. The attendance/outcomes of voice therapy resulted in patient division into five groups, those who (1) were successfully discharged from therapy, (2) attended a few sessions, had voices that improved to normal or were near normal and then stopped attending therapy, (3) attended many sessions with some voice gain, (4) failed to improve despite attending voice therapy, or (5) failed to attend voice therapy as recommended. Outcomes for groups 1–3 (53% of patients) were considered successful (positive voice change), whereas outcomes for groups 4 and 5 (47% of patients) were considered unsuccessful. A high percentage of patients (44%) essentially did not attend therapy. Patients having successful outcomes were more likely to be female, younger, employed, with fewer laryngeal diagnoses and medical problems, a less severe voice disorder and lower Voice Handicap Index (VHI) scores at the start of therapy. Patients with more complex laryngeal diagnoses, more perceived vocal severity, occupational issues, more health issues, and higher VHI scores at the time of the initial voice evaluation may be at greater risk for failing to attend voice therapy sessions.

from the Journal of Voice

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Patient Factors Related to Voice Therapy Attendance and Outcomes

Limited information is available concerning factors that may be associated with attendance and outcomes among patients referred for voice therapy. The purpose of this study was to determine whether patient-related factors could be identified which distinguished patients who attended voice therapy and had positive voice change from those who did not. This retrospective study included medical record information for 100 patients seen at a major urban, academic medical center. The attendance/outcomes of voice therapy resulted in patient division into five groups, those who (1) were successfully discharged from therapy, (2) attended a few sessions, had voices that improved to normal or were near normal and then stopped attending therapy, (3) attended many sessions with some voice gain, (4) failed to improve despite attending voice therapy, or (5) failed to attend voice therapy as recommended. Outcomes for groups 1–3 (53% of patients) were considered successful (positive voice change), whereas outcomes for groups 4 and 5 (47% of patients) were considered unsuccessful. A high percentage of patients (44%) essentially did not attend therapy. Patients having successful outcomes were more likely to be female, younger, employed, with fewer laryngeal diagnoses and medical problems, a less severe voice disorder and lower Voice Handicap Index (VHI) scores at the start of therapy. Patients with more complex laryngeal diagnoses, more perceived vocal severity, occupational issues, more health issues, and higher VHI scores at the time of the initial voice evaluation may be at greater risk for failing to attend voice therapy sessions.

from the Journal of Voice

ro_utddb1202

Evolution of communication abilities after cochlear implantation in prelingually deaf children

Many different factors influence the evolution of communication abilities of cochlear implanted children.

Investigating the cause of hearing loss, presence of associated disabilities and residual hearing before surgery may help to predict outcome and plan appropriate care to those children with negative predictive factors.

from the International Journal of Pediatric Otorhinolaryngology

Type I Gore-Tex Laryngoplasty for Glottic Incompetence in Mobile Vocal Folds

Gore-tex thyroplasty provides reliable medium-term improvement in both perceptual and subjective voice parameters in the setting of GI with mobile vocal folds.

from the Journal of Voice

Short and Long Compression Release Times: Speech Understanding, Real-World Preferences, and Association with Cognitive Ability

The relationship between cognitive abilities and performance with short and long release time processing was supported and further elucidated in this research. In addition, release time was seen to be a salient variable in subjective performance with amplification in daily life. Accurate prospective prescription of release time has the potential to make a material contribution to successful amplification provision.

from the Journal of the American Academy of Audiology

Post-treatment Speech Naturalness of Comprehensive Stuttering Program Clients and Differences in Ratings among Listener Groups R1

The purposes of this study were to investigate naturalness of the post-treatment speech of Comprehensive Stuttering Program (CSP) clients and differences in naturalness ratings by three listener groups. Listeners were 21 student speech-language pathologists, 9 community members, and 15 listeners who stutter. Listeners rated perceptually fluent speech samples of CSP clients obtained immediately post-treatment (Post) and at five years follow-up (F5), and speech samples of matched typically fluent (TF) speakers. A 9-point interval rating scale was used. A 3 (listener group) x 2 (time) x 2 (speaker) mixed ANOVA was used to test for differences among mean ratings. The difference between CSP Post and F5 mean ratings was statistically significant. The F5 mean rating was within the range reported for typically fluent speakers. Student speech-language pathologists were found to be less critical than community members and listeners who stutter in rating naturalness; however, there were no significant differences in ratings made by community members and listeners who stutter. Results indicate that the naturalness of post-treatment speech of CSP clients improves in the post-treatment period and that it is possible for clients to achieve levels of naturalness that appear to be acceptable to adults who stutter and that are within the range of naturalness ratings given to typically fluent speakers

from Journal of Fluency Disorders

Bone-anchored hearing aid A single-stage procedure in children

Conclusion
Our results show that a single-stage technique is associated with a low rate of early complications, with no reports of fixture loss due to osseointegration failure.

from the International Journal of Pediatric Otorhinolaryngology